Patients from around the globe mingled in the fourth-floor ward of the First Tianjin Central Hospital, some of them with nurses bracing their steps.

In the last few years, several Chinese hospitals have done a soaring business in liver, heart and kidney transplants. They charge barely half as much as in the West, advertise through intermediaries abroad and pull in a steady stream of patients who are unable to find donors in their home countries.

"About every nation is here," said Javed, who owns a soap factory not far from Lahore. "There are Korean, Japanese, Arabs, the whole (Persian) Gulf region. . . . There are a few guys from Israel as well."

Javed's mood turned sour only when he was asked about the donor of the liver that now was sewn firmly into his own abdomen. Did he know anything about the person?

"It isn't nice to look into these matters," he said tersely.

A variety of human rights groups—such as Amnesty International, Human Rights Watch and the Laogai Research Foundation—say donated organs in China often come from executed prisoners, and there are concerns that prisoners' wishes aren't always respected.

China's hospitals have a seemingly endless supply of organs because the country applies the death penalty more freely than any other nation. By harvesting from executed prisoners, hospitals receive a steady stream of organs and can match donors' compatibility with recipients ahead of time.

Authorities don't hide the fact that executed prisoners are a source for some organs, but they say it isn't a rampant practice.

Organs come from executed prisoners "only after they or their family members voluntarily sign donation documents," said Mao Qun'an, a spokesman for the Health Ministry. "In reality, there are very few cases of organs taken from executed prisoners. Some overseas media purposely concocted the rumor that China takes organs from executed prisoners at will. It is a malicious attack on China's judicial system."

But the rule of law is weak in China, courts aren't independent and many gray areas exist around informed consent for organ donation.

A number of social and political issues intersect in the matter of China's organ transplants. First, there's a rising level of medical sophistication. The country is among the world leaders in the number of organ transplants each year. Secondly, as China veers toward a free-market economy, institutions such as hospitals are grasping at income-generating opportunities, such as treating affluent foreigners.

Moreover, as in many aspects of the Chinese state, secrecy shrouds the execution of prisoners. China doesn't say how many prisoners it kills each year, but legal scholars say it's probably between 3,000 and 8,000.

Accusations about harvesting organs from prisoners in China have existed for several decades. But they revived in recent weeks with reports in The Epoch Times, an overseas newspaper linked to Falun Gong, a banned spiritual movement. The newspaper charged that a secret labor camp near Shenyang, in China's northeastern region, contained Falun Gong detainees who were to be executed for the express purpose of providing organs that the state would sell for a profit.

Falun Gong advocates said the Liaoning Provincial Thrombosis Hospital in Shenyang transplanted organs that were taken at the Sujiatun camp.

Deputy State Department spokesman Adam Ereli said March 31 that the Bush administration took the charges "very seriously" and he urged China to investigate.

Such allegations can't be proved or disproved easily, and a spokesman for the Foreign Ministry in Beijing, Liu Jianchao, dismissed them roundly, saying the "illegal cult" was playing "tricks in the international arena to undermine the stability of China."

Liu acknowledged, however, that a "legal vacuum" exists around organ transplants, prompting the Health Ministry to draft interim regulations March 28 to ban the sale of organs starting July 1.

Permanent regulations are in the works, prompted by reports of botched transplants in Japanese patients that led to as many as eight deaths.

Web sites in Japan, South Korea and Taiwan advertise the availability of liver and kidney transplants in China, and offer prices for the procedures.

On the Web site www.bek-transplant.com, Chinese physicians say a kidney transplant for non-Chinese citizens would cost $70,000 and a liver transplant $120,000.

"The above price covers the new organs, priority on the waiting list, the transplant surgery, hospital stay, interpreter, etc., for two months after the surgery. It does not cover your travel costs, hotel stay," the site says.

A British newspaper, the Daily Telegraph, reported in December that its reporter posed as someone interested in getting involved in organ transplants as a business venture at a hospital in Guangzhou, a southern metropolis.

"We should be cautious—this is sensitive," the newspaper quoted a hospital physician, Na Ning, as telling the reporter. The paper said Na offered a contract that provided commissions to brokers and middlemen for bringing in patients, and cut rates for more than 10 transplants.

Authorities don't reveal how many foreigners come to China for transplants each year, but if the bustling Tianjin transplant wards are any indication, the number is quite high. The hospital claims to have done about 1,000 liver transplants and 2,000 kidney transplants, making it the largest center for liver transplants in China.

South Korea's largest newspaper, Chosun Ilbo, said last year that about 1,000 Koreans a year were undergoing organ transplants in Chinese hospitals.

Patients and family members at the Tianjin hospital said that once they'd heard of the availability of organs here, they rushed to arrange operations.

Nadeem Manjj came with his uncle, Mumdaz Ali Cheema, from Pakistan last June for a third liver transplant. The first two failed because Cheema has hepatitis C, complicating the procedure.

"They say this is the last chance," Manjj said. "It's very risky to do it a third time. There's nowhere else like this. Here, the organs are available. In England or the U.S., you have to bring a donor with you."

Manjj said the fees in China were half what they'd be in Britain or the United States, "and the post-transplant care is the same."